Welcome to my blog!

I'm an acupuncturist, teacher, fertility specialist, patient centered advocate, mom, activist and more! This blog is a place for me to write down the things on my mind, the things I discuss over and over, and the things I find helpful, interesting, and inspiring all in the hope that someone else out there, maybe YOU, will find some of these things to be helpful, interesting and inspiring too. I love learning, I love sharing, and I am passionate about helping others lead more balanced, fertile, and healthy lives - while trying to do the same myself. So here goes... The Blogging Life...

9.20.2012

PCOS Mother load Part TWO Obesity and Insulin Resistance

If you missed part one of this article you can find it here. In part one I cover the causes and mechanisms of PCOS.

In the most typical presentation of PCOS a woman has additional weight (especially around the midsection - i.e. an apple shape) the very very best treatment is both incredibly simple AND difficult... weight loss...

In the Journal of Human Reproducation in 1998 a study was published that showed the difference between women who were overweight (with any diagnosis, not just PCOS) who lost weight for six months prior to trying to conceive using ART and those who did not lose weight and used ART. The pregnancy and birth rates were HUGELY improved in the weight loss group (with the average weight loss just over 22 lbs.):

Without Weight-loss
Pregnancy rates 12%

With Weight-loss
Pregnancy rates 77%

Without Weight-loss
Miscarriage rates: 75%
Live Birth rates: 3%

With Weight-loss
Miscarriage rates: 18%
Life Birth rates: 67%

When the amount of money spent on fertility treatments compared to the rate of live birth was compared, the data was staggering...

The average cost per baby for the weight-loss group was $4,600
The average cost per baby for the group who did not lose weight was $275,000!

These are some powerful statistics, but when there is insulin resistance weight gain becomes even more problematic.

Why does Insulin resistance make people gain weight (especially around the middle)?
Insulin's job is to bind together with glucose (blood sugar) in the blood stream (where the glucose is floating around and waiting to be used for energy by the cells). Once insulin binds to the glucose, it acts as a sort of key... and the glucose can bind to and pass through these little receptors on the surface of the cells all over the body. Once the glucose is inside the cell it is used to fuel the cellular function. This is how it should work.

When there is a lot of insulin in the blood stream the glucose gets let into the cells too quickly. The cells get flooded with glucose (sugar) at a rate that is not healthy or necessary. Because the body is smart, it knows this is not good. So because it cannot always control how much glucose the body has in it (that's up to the person and how they choose to eat) or how much insulin is being produced (when there is a glitch or the body is pumping it out because the diet is requiring it) the body does the only thing it has left to do to keep the cells from getting flooded with too much glucose. It cuts down the number of receptors on the cells so that the glucose cannot get in.

In an average, healthy person, each of their cells has about 20,000 receptors on its surface.
In a person with insulin resistance the average cell has about 5,000 receptors on its surface - 1/4!

So then the glucose can't get in as fast.

What happens next makes sense. The glucose is still there, but it can't get into the cells. It is floating around in the blood stream with nowhere to go and it creates congestion in the blood vessels. The tiniest capillaries in the fingers and toes get the worst, in fact, they are so small, the damage from the congestion causes inflammation and them to be blocked (microcirculation issues... which is a big deal, because the circulation to a newly implanted embryo depends on this type of blood flow). As this microcirculation gets blocked the glucose (sugar) begins to concentrate more and more in the center of the body where the bigger blood vessels are and where there is room.

The cells that are closer to the center of the body, where the glucose builds up the most have a constant and steady stream of sugar entering them. Even though they have reduced their receptors down to 1/4 of what they normally would have they get fed a non-stop supply of glucose... And the liver that is located right in the thick of where the glucose is building, converts extra glucose into fat, which get deposited nearby around the middle of the body... and this is why the apple shape type of obesity is common with insulin resistance.

In general 25% of women who are overweight are also poly-cystic (not all have fertility troubles, but many do)
In general only 5% of women who have a healthy body weight are also poly-cystic.

What is the best way to lose weight if I have insulin resistant type obesity patterns?
Exercise is key, and every little bit helps. Do not feel discouraged or like you have to go all out, just do something every day possible! Remember, the women in the study above did not lose a TON of weight, they lost an average of 22 lbs!

As for diet, one of the best way to disrupt this vicious cycle is by slowing down the sources of glucose (sugar) to the body. Certain foods are easily turned into big bursts of glucose (simple carbs and sugars do this), while other foods break down more slowly and supply a more slow and steady form of glucose to the body (proteins do this). Lots of foods fall in between (complex carbs). If you follow a high protein/low glycemic index diet you will be eating in the best way to decrease this build up of glucose in the bloodstream.

A certain type of protein has another benefit. Whey protein has an amino acid that helps regulate insulin production, so adding whey protein is a good option (in moderation).

And there are some lovely herbal formulas and acupuncture treatments to help decrease dampness (which weight is considered) and improve metabolic function, so you can always throw those into the mix!

So that's the scoop on why losing weight is important and why the weight gain happens in the first place.

In my next installment I'll be going over common treatments used for PCOS infertility... what the studies say and why Traditional Chinese medicine may very well be the best possible treatment for women with PCOS...